2010 Kenneth J.

Ryan, MD, Physician

Leadership Award
Nomination Instructions and Application

Nomination Deadline-December 18th,

2009
_______________________________________________
Nomination Instructions:
Criteria: Must be an obstetrician and gynecologist
1. Save this document to your computer before proceeding.
2. Fill out Kenneth J. Ryan, MD, Physician Leadership Award 2010 Application Form.
a. Type in the gray boxes provided on the application.
i. Must provide contact information for both the nominee and nominator.
ii. Write a description in 500 words or less of the nominee and her/his longstanding
work to improve reproductive health in: (1) research, (2) education, (3) clinical
service, and (4) advocacy over the course of her/his career.
iii. Submit nominee’s CV.
1. To enter the CV into the application, cut and paste from a word document
or you may email it with the application as an attachment.

3. When application is complete, please email the application as an attachment no later than
December 18th, 2009, to:
Penny Vick, MPH
Education and Research Senior Associate
Physicians for Reproductive Choice and Health
Email: penny@prch.org
Phone: 646-649-9930

* The 2010 Leadership Award Recipient will be notified in January. The nominator and awardee will be
honored guests at the 2010 ACOG ACM Kenneth J. Ryan, MD, Memorial Program; Award Ceremony
and Luncheon.

Please see application form below.

 Application Form: 2010 Kenneth J. Ryan, M.D. Physician Leadership Award
Date:      
Nominator General Information:
Full Name:                  
Last First M.I.
Title:      

Specialty:      

Contact Information:            

Street address Apt/Suite
                 
City State ZIP Code
           
Email Phone

Nominee General Information:

Full Name:                  

Last First M.I.
Title:      

Specialty:      
     
Work Contact
Information: Department
           

Street Address Apt/Suite

                 
City State ZIP Code
           
Email Phone

Nominee’s CV: (cut & paste)

Insert CV here by cutting and pasting from a word document, or you may send the CV as an email attachment to
penny@prch.org with the application.

500 word Description of Nominee: (follow directions below)

Below, please describe in 500 words or less the nominee and her/his longstanding work to improve
reproductive health in; (1) research, (2) education, (3) clinical service, and (4) advocacy over the course
of their career. Descriptions should include specific examples of the nominee’s particularly successful work in all
four areas and the resulting substantial improvements to reproductive health.
Type here